7 Discussie en conclusie
7.3 Gevolgen van ABR in het milieu voor de volksgezondheid
Uit dit rapport blijkt dat ABR in het milieu wordt gebracht via afvalwater en mest. Mensen kunnen in meerdere of mindere mate aan ABR in milieucompartimenten worden blootgesteld. Een voorbeeld zijn ESBL- producerende bacteriën in recreatiewater onder invloed van afvalwater waarbij het zeer aannemelijk is dat mensen worden blootgesteld (Schijven et al., 2015).
Naast blootstelling aan ABR via het milieu vindt blootstelling aan ABR ook via vele andere routes plaats, zoals direct contact met mensen of dieren, door voedselconsumptie of bij een ziekenhuisopname. Omdat ABR via vele routes van en naar de mens overgedragen kan worden, is onderzoek naar de precieze bijdrage van alle verschillende bronnen complex van aard. Deze kennis zal naar verwachting ook niet binnen afzienbare tijd ter beschikking komen.
Voor enkele andere pathogenen bestaat al meer kennis over de bijdrage van verschillende routes, en is inzichtelijk dat overdracht via het milieu mogelijk is. Voor Campylobacter, Salmonella en shiga toxine
producerende E. coli werd geschat dat blootstelling via water ongeveer 10% van de blootstelling kan verklaren, naast blootstelling via voedsel (Hald et al., 2016). Ook zijn de risico’s verbonden met enkele specifieke routes van overdracht van resistente bacteriën onderzocht, zoals reizen naar bijvoorbeeld Azië of Zuid-Amerika (Arcilla et al., 2017; Paltansing et al., 2013), ziekenhuisopnames of overdracht tussen leden van een huishouden (Haverkate et al., 2017). Voor de bacterie MRSA, maar niet voor ESBL-EC, werd recent een lichte verhoging van het dragerschap onder omwonenden van veehouderijen aangetoond (Maassen et al., 2016). Samenvattend is over de mate van blootstelling via het milieu in relatie tot deze andere bronnen nog weinig bekend.
Ook studies naar de mogelijke gevolgen van blootstelling aan ABR in het milieu voor de volksgezondheid zijn vooralsnog niet beschreven, zoals ook werd geconcludeerd door Huijbers et al. (2015). De complexiteit van de keten blootstelling, kolonisatie, en ziekte speelt daarin een rol:
van infecties. Mensen kunnen deze bacteriën ook bij zich dragen zonder ziektes te ontwikkelen. Deze relatie tussen blootstelling aan resistente bacteriën en ontwikkeling van ziekteverschijnselen is voor blootstelling aan ABR in het milieu net zo onbekend als voor andere
blootstellingroutes, zoals consumptie van vlees of direct contact met dieren of mensen.
Het is van belang om te weten of blootstelling aan ABR in het milieu leidt tot nadelige gevolgen voor de volksgezondheid. Bovendien is het van belang te weten in welke mate dit gebeurt en hoe omvangrijk de gevolgen zijn, om beter af te kunnen wegen in welke mate maatregelen nodig zijn om de blootstelling aan ABR te verminderen. In algemene zin is het voorkomen van verspreiding van ABR naar het milieu wenselijk. Methoden om de gezondheidsgevolgen van blootstelling aan ABR te onderzoeken omvatten epidemiologische studies naar dragerschap van ABR in mensen die via een bepaalde route zijn blootgesteld,
kwantitatieve analyses van de blootstelling aan resistente bacteriën, en ziektelastschattingen. Verschillende strategieën om de ernst en impact door blootstelling aan ABR in het milieu te kwantificeren worden in Bijlage 9.12 nader beschreven.
Op korte termijn bieden epidemiologische studies van mensen die via een bepaalde route aan ABR in het milieu zijn blootgesteld (zoals door zwemmen in oppervlaktewater of door beroepsmatige blootstelling) de mogelijkheid om gevolgen van blootstelling voor dragerschap van BRMO te onderzoeken. Ook kan de opname van ABR via verschillende
blootstellingsroutes onderzocht worden. Dit kan helpen om het relatieve belang van verschillende blootstellingsroutes te vergelijken.
8
Referenties
Aalderink, H. & Moens, M.R. 2002. Maatregelenmatrix emissie- /waterkwaliteitsspoor. 2002-03. STOWA.
Adamek, E., Baran, W. & Sobczak, A. 2016. Photocatalytic degradation of veterinary antibiotics: Biodegradability and antimicrobial activity of intermediates. Process Safety and Environmental Protection, 103, 1-9. Alexander, J., Knopp, G., Dötsch, A., Wieland, A. & Schwartz, T. 2016. Ozone treatment of conditioned wastewater selects antibiotic resistance genes, opportunistic bacteria, and induce strong population shifts.
Science of the Total Environment, 559, 103-112.
Anonymous 2001. ISO 16649-2 Microbiology of food and animal feeding stuffs - Horizontal method for the enumeration of beta-glucuronidase- positive Escherichia coli - part 2: Colony count technique at 44ºC using 5-bromo-4-chloro-3-indolyl beta-D-glucuronide.
Arcilla, M.S., van Hattem, J.M., Haverkate, M.R., Bootsma, M.C., van Genderen, P.J., Goorhuis, A., Grobusch, M.P., Lashof, A.M., Molhoek, N., Schultsz, C., Stobberingh, E.E., Verbrugh, H.A., de Jong, M.D., Melles, D.C. & Penders, J. 2017. Import and spread of extended-spectrum beta- lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect
Dis, 17, 78-85.
Arora, S. & Kazmi, A.A. 2016. Reactor performance and pathogen removal during wastewater treatment by vermifiltration. Journal of
Water Sanitation and Hygiene for Development, 6, 65-73.
Arturo-Schaan, M., Tamanai-Shacoori, Z. & Cormier, M. 1995. Stability of plasmid-borne resistance of antibiotics during starvation of
Escherichia coli in raw and treated waste water and brackish water.
Water Science and Technology, 31, 199-202.
Bagge, E., Sahlstrom, L. & Albihn, A. 2005. The effect of hygienic
treatment on the microbial flora of biowaste at biogas plants. Water Res, 39, 4879-86.
Batelaan, M.V., van den Berg, E.A., Koetse, E. & Wortel, N. 2012. Evaluatierapport Pharmafilter. 2012-29. STOWA.
Bengtsson-Palme, J. & Larsson, D.G. 2016. Concentrations of antibiotics predicted to select for resistant bacteria: Proposed limits for
environmental regulation. Environ Int, 86, 140-9.
Berendsen, B.J., Wegh, R.S., Memelink, J., Zuidema, T. & Stolker, L.A. 2015. The analysis of animal faeces as a tool to monitor antibiotic usage. Talanta, 132, 258-68.
Biswal, B.K., Khairallah, R., Bibi, K., Mazza, A., Gehr, R., Masson, L. & Frigon, D. 2014. Impact of UV and peracetic acid disinfection on the prevalence of virulence and antimicrobial resistance genes in
uropathogenic escherichia coli in wastewater effluents. Applied and
Environmental Microbiology, 80, 3656-3666.
Blaak, H., Lynch, G., Italiaander, R., Hamidjaja, R.A., Schets, F.M. & De Husman, A.M. R. 2015. Multidrug-resistant and extended spectrum beta-lactamase-producing escherichia coli in dutch surface water and wastewater. PLoS ONE, 10.
Bonetta, S., Ferretti, E., Bonetta, S., Fezia, G. & Carraro, E. 2011. Microbiological contamination of digested products from anaerobic co- digestion of bovine manure and agricultural by-products. Letters in
Applied Microbiology, 53, 552-557.
Bréchet, C., Plantin, J., Sauget, M., Thouverez, M., Talon, D., Cholley, P., Guyeux, C., Hocquet, D. & Bertrand, X. 2014. Wastewater treatment plants release large amounts of extended-spectrum β-lactamase-
producing escherichia coli into the environment. Clinical Infectious
Diseases, 58, 1658-1665.
Buelow, E. 2016. The human gut microbiota as a reservoir of antibiotic resistance. PhD, Utrecht University.
Calero-Cáceres, W. & Muniesa, M. 2016. Persistence of naturally occurring antibiotic resistance genes in the bacteria and bacteriophage fractions of wastewater. Water Research, 95, 11-18.
Canter, N. 2008. Removing microbes from water. Tribology and
Lubrication Technology, 64, 12-13.
Cattoir, V. & Leclercq, R. 2013. Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce? J Antimicrob
Chemother, 68, 731-42.
Centraal Bureau voor de Statistiek 2016a. Dierlijke mest; productie, transport en gebruik; kerncijfers.
Centraal Bureau voor de Statistiek 2016b. Huishoudens; grootte, samenstelling, positie in het huishouden, 1 januari.
Chee-Sanford, J.C., Mackie, R.I., Koike, S., Krapac, I.G., Lin, Y.F., Yannarell, A.C., Maxwell, S. & Aminov, R.I. 2009. Fate and transport of antibiotic residues and antibiotic resistance genes following land
application of manure waste. J Environ Qual, 38, 1086-108.
Childress, H., Sullivan, B., Kaur, J. & Karthikeyan, R. 2014. Effects of ultraviolet light disinfection on tetracycline-resistant bacteria in wastewater effluents. Journal of Water and Health, 12, 404-409. Commissie integraal waterbeheer 2001a. Riooloverstorten Deel 1: Knelpuntcriteria riooloverstorten.
Commissie integraal waterbeheer 2001b. Riooloverstorten Deel 2: Eenduidige basisinspanning
Conte, D., Palmeiro, J.K., da Silva Nogueira, K., de Lima, T.M.R., Cardoso, M.A., Pontarolo, R., Degaut Pontes, F.L. & Dalla-Costa, L.M. 2017. Characterization of CTX-M enzymes, quinolone resistance determinants, and antimicrobial residues from hospital sewage, wastewater treatment plant, and river water. Ecotoxicology and
Environmental Safety, 136, 62-69.
Cote, C., Masse, D. I. & Quessy, S. 2006. Reduction of indicator and pathogenic microorganisms by psychrophilic anaerobic digestion in swine slurries. Bioresour technol, 97, 686-91.
Côté, C., Villeneuve, A., Lessard, L. & Quessy, S. 2006. Fate of
pathogenic and nonpathogenic microorganisms during storage of liquid hog manure in Québec. Livestock Science, 102, 204-210.
Czekalski, N., Gascon Diez, E. & Burgmann, H. 2014. Wastewater as a point source of antibiotic-resistance genes in the sediment of a
freshwater lake. ISME J, 8, 1381-90.
Czekalski, N., Imminger, S., Salhi, E., Veljkovic, M., Kleffel, K., Drissner, D., Hammes, F., Bürgmann, H. & Von Gunten, U. 2016. Inactivation of Antibiotic Resistant Bacteria and Resistance Genes by Ozone: From Laboratory Experiments to Full-Scale Wastewater Treatment.
Environmental Science and Technology, 50, 11862-11871.
Da Silva, M.F., Tiago, I., Veríssimo, A., Boaventura, R.A., Nunes, O.C. & Manaia, C.M. 2006. Antibiotic resistance of enterococci and related bacteria in an urban wastewater treatment plant. FEMS Microbiology
Ecology, 55, 322-329.
de Cazes, M., Belleville, M.P., Petit, E., Salomo, M., Bayer, S., Czaja, R., De Gunzburg, J. & Sanchez-Marcano, J. 2016. Erythromycin degradation by esterase (EreB) in enzymatic membrane reactors. Biochemical
Engineering Journal, 114, 70-78.
DELTARES & TNO 2016. Effluenten RWZI’s, regenwaterriolen, niet aangesloten riolen, overstorten en IBA’s. Emissieschattingen Diffuse
bronnen Emissieregistratie.
Drieux-Rouzet, L. & Jarlier, V. 2014. Multiresistant bacteria and water: The model of ESBL-producing enterobacteria. Revue Francophone des
Laboratoires, 2014, 75-79.
Dunlop, P.S.M., Ciavola, M., Rizzo, L., McDowell, D.A. & Byrne, J.A. 2015. Effect of photocatalysis on the transfer of antibiotic resistance genes in urban wastewater. Catalysis Today, 240, 55-60.
Elmi, F., Alinezhad, H., Moulana, Z., Salehian, F., Tavakkoli, S.M., Asgharpour, F., Fallah, H. & Elmi, M.M. 2014. The use of antibacterial activity of ZnO nanoparticles in the treatment of municipal wastewater.
Espinoza-Quiñones, F.R., de Souza, A.R.C., Módenes, A.N., Trigueros, D.E.G., de Pauli, A.R., de Souza, P.S.C. & Kroumov, A.D. 2016. Removal Performance, Antibacterial Effects, and Toxicity Assessment of
Ciprofloxacin Treated by the Electrocoagulation Process. Water, Air, and
Soil Pollution, 227.
Fahrenfeld, N., Knowlton, K., Krometis, L.A., Hession, W.C., Xia, K., Lipscomb, E., Libuit, K., Green, B.L. & Pruden, A. 2014. Effect of manure application on abundance of antibiotic resistance genes and their
attenuation rates in soil: field-scale mass balance approach. Environ Sci
Technol, 48, 2643-50.
Ferro, G., Fiorentino, A., Alferez, M.C., Polo-López, M.I., Rizzo, L. & Fernández-Ibáñez, P. 2014. Urban wastewater disinfection for
agricultural reuse: Effect of solar driven AOPs in the inactivation of a multidrug resistant E. coli strain. Applied Catalysis B: Environmental, 178.
Ferro, G., Guarino, F., Castiglione, S. & Rizzo, L. 2016. Antibiotic
resistance spread potential in urban wastewater effluents disinfected by UV/H2O2 process. Science of the Total Environment, 560-561, 29-35. Fierer, N., Jackson, J. A., Vilgalys, R. & Jackson, R. B. 2005. Assessment of Soil Microbial Community Structure by Use of Taxon-Specific
Quantitative PCR Assays. Applied and Environmental Microbiology, 71, 4117-4120.
Finch, G.R. & Smith, D.W. 1987. Ozone disinfection of secondary
effluent containing antibiotic-resistant Escherichia coli. Canadian journal
of civil engineering, 14, 234-238.
Fiorentino, A., Ferro, G., Alferez, M.C., Polo-Lóez, M. I., Fernández- Ibañez, P. & Rizzo, L. 2015. Inactivation and regrowth of multidrug resistant bacteria in urban wastewater after disinfection by solar-driven and chlorination processes. Journal of Photochemistry and Photobiology
B: Biology, 148, 43-50.
Fremaux, B., Delignette-Muller, M.L., Prigent-Combaret, C., Gleizal, A. & Vernozy-Rozand, C. 2007. Growth and survival of non-O157:H7 Shiga- toxin-producing Escherichia coli in cow manure. J Appl Microbiol, 102, 89-99.
Galler, H., Feierl, G., Petternel, C., Reinthaler, F.F., Haas, D., Grisold, A.J., Luxner, J. & Zarfel, G. 2014. KPC-2 and OXA-48 carbapenemase- harbouring Enterobacteriaceae detected in an Austrian wastewater treatment plant. Clin Microbiol Infect, 20, O132-4.
Garcia, S., Wade, B., Bauer, C., Craig, C., Nakaoka, K. & Lorowitz, W. 2007. The effect of wastewater treatment on antibiotic resistance in Escherichia coli and Enterococcus sp. Water Environment Research, 79, 2387-2395.
Girlich, D., Poirel, L., Szczepanowski, R., Schluter, A. & Nordmann, P. 2012. Carbapenem-hydrolyzing GES-5-encoding gene on different plasmid types recovered from a bacterial community in a sewage treatment plant. Appl Environ Microbiol, 78, 1292-5.
Guardabassi, L., Lo Fo Wong, D.M.A. & Dalsgaard, A. 2002. The effects of tertiary wastewater treatment on the prevalence of antimicrobial resistant bacteria. Water Research, 36, 1955-1964.
Gullberg, E., Cao, S., Berg, O.G., Ilback, C., Sandegren, L., Hughes, D. & Andersson, D.I. 2011. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog, 7, e1002158.
Haack, S.K., Duris, J.W., Fogarty, L.R., Kolpin, D.W., Focazio, M.J., Furlong, E.T. & Meyer, M.T. 2009. Comparing wastewater chemicals, indicator bacteria concentrations, and bacterial pathogen genes as fecal pollution indicators. Journal of Environmental Quality, 38, 248-258. Hald, T., Aspinall, W., Devleesschauwer, B., Cooke, R., Corrigan, T., Havelaar, A.H., Gibb, H.J., Torgerson, P.R., Kirk, M.D., Angulo, F.J., Lake, R.J., Speybroeck, N. & Hoffmann, S. 2016. World Health Organization Estimates of the Relative Contributions of Food to the Burden of Disease Due to Selected Foodborne Hazards: A Structured Expert Elicitation. PLoS One, 11, e0145839.
Harris, S., Morris, C., Morris, D., Cormican, M. & Cummins, E. 2014. Antimicrobial resistant Escherichia coli in the municipal wastewater system: Effect of hospital effluent and environmental fate. Science of
the Total Environment, 468-469, 1078-1085.
Haverkate, M.R., Platteel, T.N., Fluit, A.C., Cohen Stuart, J.W., Leverstein-van Hall, M.A., Thijsen, S.F., Scharringa, J., Kloosterman, R.C., Bonten, M.J. & Bootsma, M.C. 2017. Quantifying within-household transmission of extended-spectrum beta-lactamase-producing bacteria.
Clin Microbiol Infect, 23, 46 e1-46 e7.
Heß, S. & Gallert, C. 2015. Sensitivity of antibiotic resistant and
antibiotic susceptible Escherichia coli, Enterococcus and Staphylococcus strains against ozone. Journal of Water and Health, 13, 1020-1028. Heuer, H., Schmitt, H. & Smalla, K. 2011. Antibiotic resistance gene spread due to manure application on agricultural fields. Curr Opin
Microbiol, 14, 236-43.
Hocquet, D., Muller, A. & Bertrand, X. 2016. What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems. Journal of Hospital Infection, 93, 395-402.
Hoeksma, P., Aarnink, A.J.A., de Buisonjé, F.E., Rutjes, S.A. & Blaak, H. 2015. Effect van processtappen op overleving van micro-organismen bij mestverwerking. In: WUR (ed.) Rapport 839.
Homem, V. & Santos, L. 2011. Degradation and removal methods of antibiotics from aqueous matrices - a review. J Environ Manage, 92, 2304-47.
Hu, Q., Zhang, X.X., Jia, S., Huang, K., Tang, J., Shi, P., Ye, L. & Ren, H. 2016. Metagenomic insights into ultraviolet disinfection effects on antibiotic resistome in biologically treated wastewater. Water Research, 101, 309-317.
Huang, J.J., Hu, H.Y., Wu, Y.H., Wei, B. & Lu, Y. 2013. Effect of chlorination and ultraviolet disinfection on tetA-mediated tetracycline resistance of Escherichia coli. Chemosphere, 90, 2247-2253.
Huijbers, P.M., Blaak, H., de Jong, M.C., Graat, E.A., Vandenbroucke- Grauls, C.M. & de Roda Husman, A.M. 2015. Role of the Environment in the Transmission of Antimicrobial Resistance to Humans: A Review.
Environ Sci Technol, 49, 11993-2004.
Jansen, E.J. & van den Bos, L. 2010. Knelpuntenbeoordelingsmethode waterkwaliteitsspoor overstorten. 2010-17. STOWA.
Jung, C.M., Heinze, T.M., Strakosha, R., Elkins, C.A. & Sutherland, J.B. 2009. Acetylation of fluoroquinolone antimicrobial agents by an
Escherichia coli strain isolated from a municipal wastewater treatment plant. Journal of Applied Microbiology, 106, 564-571.
Kadir, K. & Nelson, K.L. 2014. Sunlight mediated inactivation
mechanisms of Enterococcus faecalis and Escherichia coli in clear water versus waste stabilization pond water. Water Research, 50, 307-317. Kalaiselvi, K., Mangayarkarasi, V., Balakrishnan, D. & Chitraleka, V. 2016. Survival of antibacterial resistance microbes in hospital-generated recycled wastewater. Journal of Water and Health, 14, 942-949.
Karaolia, P., Michael-Kordatou, I., Hapeshi, E., Alexander, J., Schwartz, T. & Fatta-Kassinos, D. 2017. Investigation of the potential of a
Membrane BioReactor followed by solar Fenton oxidation to remove antibiotic-related microcontaminants. Chemical Engineering Journal, 310, 491-502.
Karaolia, P., Michael, I., García-Fernández, I., Agüera, A., Malato, S., Fernández-Ibáñez, P. & Fatta-Kassinos, D. 2014. Reduction of
clarithromycin and sulfamethoxazole-resistant Enterococcus by pilot- scale solar-driven Fenton oxidation. Science of the Total Environment, 468-469, 19-27.
Kearney, T.E., Larkin, M.J., Frost, J.P. & Levett, P.N. 1993. Survival of pathogenic bacteria during mesophilic anaerobic digestion of animal waste. J Appl Bacteriol, 75, 215-9.
Khan, S.J. & Ongerth, J.E. 2004. Modelling of pharmaceutical residues in Australian sewage by quantities of use and fugacity calculations.
Kibbee, R.J. & Örmeci, B. 2017. Development of a sensitive and false- positive free PMA-qPCR viability assay to quantify VBNC Escherichia coli and evaluate disinfection performance in wastewater effluent. Journal of
Microbiological Methods, 132, 139-147.
Knapp, C. W., Zhang, W., Sturm, B. S. M. & Graham, D. W. 2010. Differential fate of erythromycin and beta-lactam resistance genes from swine lagoon waste under different aquatic conditions. Environmental
Pollution, 158, 1506-1512.
Koivunen, J., Siitonen, A. & Heinonen-Tanski, H. 2003. Elimination of enteric bacteria in biological-chemical wastewater treatment and tertiary filtration units. Water Research, 37, 690-698.
Korzeniewska, E., Korzeniewska, A. & Harnisz, M. 2013. Antibiotic resistant Escherichia coli in hospital and municipal sewage and their emission to the environment. Ecotoxicology and Environmental Safety, 91, 96-102.
Kuo, J. & Chan, T.F. 2012. Disinfection and antimicrobial processes.
Water Environment Research, 84, 1286-1309.
Kuo, J.F. & Chen, J. 2006. Disinfection and Antimicrobial Processes.
Water Environment Research, 78, 1406-1428.
Leverstein-van Hall, M., Cohen Stuart, J.W., Voets, G., Versteeg, D., Roelofsen, E. & Fluit, A. 2010. Carbapenem-resistant Klebsiella pneumoniae following foreign travel. Nederlands tijdschrift voor
geneeskunde, 154, A2013-A2013.
Li, Y., Qu, X., Yu, R. & Ikehata, K. 2015. Health effects associated with wastewater treatment, reuse, and disposal. Water Environment
Research, 87, 1817-1848.
Lienert, J., Gudel, K. & Escher, B. I. 2007. Screening method for ecotoxicological hazard assessment of 42 pharmaceuticals considering human metabolism and excretory routes. Environ Sci Technol, 41, 4471- 8.
Liu, M., Zhang, Y., Yang, M., Tian, Z., Ren, L. & Zhang, S. 2012. Abundance and distribution of tetracycline resistance genes and mobile elements in an oxytetracycline production wastewater treatment system. Environmental Science and Technology, 46, 7551-7557. Lopes, T.R., Periotto, F. & Pletsch, A.L. 2017. Bacterial resistance in sanitary sewage sludge in different treatment systems. Management of
Environmental Quality, 28, 32-42.
Lucena, F., Duran, A.E., Morón, A., Calderón, E., Campos, C., Gantzer, C., Skraber, S. & Jofre, J. 2004. Reduction of bacterial indicators and bacteriophages infecting faecal bacteria in primary and secondary
Luczkiewicz, A., Jankowska, K., Bray, R., Kulbat, E., Quant, B.,
Sokolowska, A. & Olanczuk-Neyman, K. 2011. Antimicrobial resistance of fecal indicators in disinfected wastewater. Water Science and
Technology, 64, 2352-2361.
Lüddeke, F., Hess, S., Gallert, C., Winter, J., Gude, H. & Loffler, H. 2015a. Removal of total and antibiotic resistant bacteria in advanced wastewater treatment by ozonation in combination with different filtering techniques. Water Res, 69, 243-51.
Lüddeke, F., Hess, S., Gallert, C., Winter, J., Güde, H. & Löffler, H. 2015b. Removal of total and antibiotic resistant bacteria in advanced wastewater treatment by ozonation in combination with different filtering techniques. Water Research, 69, 243-251.
Luo, Y., Guo, W., Ngo, H.H., Nghiem, L.D., Hai, F.I., Zhang, J., Liang, S. & Wang, X.C. 2014. A review on the occurrence of micropollutants in the aquatic environment and their fate and removal during wastewater treatment. Sci Total Environ, 473-474, 619-41.
Luprano, M.L., De Sanctis, M., Del Moro, G., Di Iaconi, C., Lopez, A. & Levantesi, C. 2016. Antibiotic resistance genes fate and removal by a technological treatment solution for water reuse in agriculture. Science
of the Total Environment, 571, 809-818.
Maassen, K., Smit, L., Wouters, I., van Duijkeren, E., Janse, I., Hagenaars, T., IJzermans, J., van der Hoek, W. & Heederik, D. 2016. Veehouderij en gezondheid omwonenden. In: RIVM (ed.) report. RIVM. Macku'ak, T., Nagyová, K., Faberová, M., Grabic, R., Koba, O., Gál, M. & Birošová, L. 2015. Utilization of Fenton-like reaction for antibiotics and resistant bacteria elimination in different parts of WWTP. Environmental
Toxicology and Pharmacology, 40, 492-497.
Marti, E., Jofre, J. & Balcazar, J. L. 2013. Prevalence of Antibiotic Resistance Genes and Bacterial Community Composition in a River Influenced by a Wastewater Treatment Plant. PLoS ONE, 8, e78906. Martins da Costa, P., Vaz-Pires, P. & Bernardo, F. 2006. Antimicrobial resistance in Enterococcus spp. isolated in inflow, effluent and sludge from municipal sewage water treatment plants. Water Research, 40, 1735-1740.
Masse, D.I., Saady, N.M. & Gilbert, Y. 2014. Potential of Biological Processes to Eliminate Antibiotics in Livestock Manure: An Overview.
Animals (Basel), 4, 146-63.
McCarthy, G., Lawlor, P.G., Carney, K.N., Zhan, X., Gutierrez, M. & Gardiner, G.E. 2015. An investigation into the removal of Salmonella and enteric indicator bacteria from the separated liquid fraction of raw or anaerobically digested pig manure using novel on-farm woodchip biofilters. Science of the Total Environment, 514, 140-146.
McCarthy, G., Lawlor, P.G., Gutierrez, M. & Gardiner, G.E. 2013. Assessing the biosafety risks of pig manure for use as a feedstock for composting. Sci Total Environ, 463-464, 712-9.
Mendez, J.M., Jimenez, B. & Maya, C. 2004. Disinfection kinetics of pathogens in physicochemical sludge treated with ammonia. Water
Science and Technology.
Mevius, D., Dierikx, C., Veldman, K. & Wit, B. 2015. MARAN 2015. Central Veterinary Institute of Wageningen University and Research Centre.
Michael-Kordatou, I., Andreou, R., Iacovou, M., Frontistis, Z., Hapeshi, E., Michael, C. & Fatta-Kassinos, D. 2017. On the capacity of ozonation to remove antimicrobial compounds, resistant bacteria and toxicity from urban wastewater effluents. Journal of Hazardous Materials, 323, 414- 425.
Michael, I., Hapeshi, E., Michael, C., Varela, A.R., Kyriakou, S., Manaia, C.M. & Fatta-Kassinos, D. 2012. Solar photo-Fenton process on the abatement of antibiotics at a pilot scale: Degradation kinetics, ecotoxicity and phytotoxicity assessment and removal of antibiotic resistant enterococci. Water Research, 46, 5621-5634.
Michael, I., Rizzo, L., McArdell, C.S., Manaia, C.M., Merlin, C., Schwartz, T., Dagot, C. & Fatta-Kassinos, D. 2013. Urban wastewater treatment plants as hotspots for the release of antibiotics in the environment: a review. Water Res, 47, 957-95.
Moermond, C.T.A., Smit, C.E., van Leerdam, R.C., van der Aa, N.G.F.M. & Montforts, M.H.M.M. 2016. Geneesmiddelen en waterkwailteit. 2016-
0111. RIVM.
Moriarty, E., Nourozi, F., Robson, B., Wood, D. & Gilpin, B. 2008. Evidence for growth of enterococci in municipal oxidation ponds,
obtained using antibiotic resistance analysis. Applied and Environmental
Microbiology, 74, 7204-7210.
Mulder, M., Antakyali, D. & Ante, S. 2015. Verwijdering van
microverontreinigingen uit effluenten van RWZIs. 2015-27. STOWA. Munakata, N. & Kuo, J. 2014. Disinfection processes. Water Environment
Research, 86, 1250-1273.
Munir, M., Wong, K. & Xagoraraki, I. 2011. Release of antibiotic resistant bacteria and genes in the effluent and biosolids of five wastewater utilities in Michigan. Water Res, 45, 681-93.
Nagulapally, S.R., Ahmad, A., Henry, A., Marchin, G.L., Zurek, L. & Bhandari, A. 2009. Occurrence of ciprofloxacin-, trimethoprim- sulfamethoxazole-, and vancomycin-resistant bacteria in a municipal wastewater treatment plant. Water Environment Research, 81, 82-90.
Narciso-da-Rocha, C. & Manaia, C.M. 2017. The influence of the autochthonous wastewater microbiota and gene host on the fate of invasive antibiotic resistance genes. Science of the Total Environment, 575, 932-940.
Osińska, A., Korzeniewska, E., Harnisz, M. & Niestępski, S. 2017. The prevalence and characterization of antibiotic-resistant and virulent Escherichia coli strains in the municipal wastewater system and their environmental fate. Science of the Total Environment, 577, 367-375. Pablos, C., Van Grieken, R., Marugań, J. & Muñoz, A. 2012.
Simultaneous photocatalytic oxidation of pharmaceuticals and
inactivation of Escherichia coli in wastewater treatment plant effluents with suspended and immobilised TiO2. Water Science and Technology,